Routine inspection·February 21, 2024

On 02/21/2024 Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced 1 year annual inspection visit. LPA met with caregiver Elnora Panilag and explained the purpose of today's visit. LPA toured the facility inside and outside. Emergency exit routes are free and clear of obstructions. The facility's ambient temperature is comfortable and warm. Water is tested in two communal bathrooms as being 120F. Residents have an adequate amount of linens and incontinence supplies, incidental supplies, as well as PPE as needed. One fire extinguisher is observed in the kitchen. Upon observation of the charge on the dial display it is within the green zone indicating it is charged and ready for use. The inspection tag indicates it was last inspected on 09/25/2022. Facility is equipped with fire sprinklers. Carbon monoxide detectors and smoke detectors are present through out the facility. Two resident bathrooms were observed to be in good repair. Client bathrooms are observed to be in working order with clean shower curtains and non-skid surfacing and strips are in place. 7 day non-perishable food supply and 2 day fresh food supply is observed as in place. Kitchen is observed as operable and clean. Appliances are in good working order. LPA observed that the knives for cooking is locked in a small cabinet next to the stove. Medications are also observed as locked in a stand up cabinet in the kitchen. Medications are inaccessible to residents. Medication administration record is observed as current. First aid kit is observed with the medications as complete. 2 resident files are reviewed as being current. Continue on next page... Page 2 - LIC809C On site laundry is available and functioning per observations made in the garage. Cleaning supplies are observed as locked in garage and in storage cabinets in the garage. An additional refrigerator is located in the garage that contains additional resident food as well as staff's personal food items. 2 client records are checked and both are complete and updated. At time of inspection, there is only one resident who has money being stored for safekeeping by staff. This is inspected and is observed as current. 3 Staff files are reviewed as current. At time of inspection. There is one staff (S1) not associated to the facility and no fingerprint clearance on record with the Department. The following updated items are requested to be sent to the Department by 02/28/2024 : • LIC610D Emergency Disaster Plan • LIC 308 Designation of Administrative Responsibility • LIC 500 Personnel Report • Updated administrator certificate • LIC9020 Client Roster • Certificate of Liability Insurance • Proof of control of property • Surety bond with expiration date Citations issued on following LIC809D. Civil penalty assessed for staff person with no finger print clearance on file with the Department and not being associated to the facility. S1 x (2 violations) at $100 = $200 Report is reviewed with caregiver Elnora Panilag.